June 8, 2005

Woman Has Child After Receiving Twin's Ovarian Tissue
By DENISE GRADY
http://www.nytimes.com/2005/06/08/science/08transplant.html?th=&emc=th&pagewanted=print

A 25-year-old woman who had been unable to have children gave birth to a healthy daughter on Monday night in Alabama, about 15 months after receiving a transplant of ovarian tissue from her identical twin sister.

The new mother, Stephanie Yarber of Muscle Shoals, Ala., is the first woman to have a baby after an ovarian tissue transplant from another person, her doctors said.

The birth does not open the door to widespread use of ovarian transplants to cure infertility, at least not immediately, doctors said.

Ms. Yarber had no need for antirejection drugs, because her sister was a perfect match genetically. In women who are not identical twins, drugs would be needed to prevent rejection. The drugs can have harsh side effects, which would raise ethics questions about the procedure, because unlike other organ transplants it is not necessary to save the recipient's life.

"But one day, no doubt, the rejection problem will be overcome and we won't need the drugs, or we won't need them for long," said Dr. Roger G. Gosden, a professor of reproductive biology at Weill Medical College of Cornell University and a member of the team that treated the sisters. "Then the procedure could be used very widely, and will replace a lot of conventional egg donation."

The transplant was performed last year at St. Luke's Hospital in St. Louis by Dr. Sherman J. Silber. The surgery is described in an article that The New England Journal of Medicine released on its Web site yesterday and that will be published in its July 7 issue.

A spokeswoman for the journal, Karen Pedersen, said the editors had accepted the article on the condition that a healthy baby would be born and planned to release it as soon as the birth occurred.

Dr. Silber said the fact that transplanted ovarian tissue could produce a healthy child offered hope to women with cancer who must undergo chemotherapy that would damage their ovaries and leave them infertile. Those women could have their own ovarian tissue removed and frozen before starting chemotherapy, and then transplanted back when the cancer treatment was finished and they were well again.

Last September, researchers in Belgium reported the first birth of a child as a result of that procedure, but there was some skepticism about the case because the doctors had removed only one ovary from the patient, and it was not clear whether her pregnancy came from the transplanted tissue or from the ovary that had been left behind.

"I think this is absolute proof of concept that they can get pregnant," Dr. Silber said.

Ms. Yarber was unable to have children because, for unknown reasons, she reached menopause at age 14. She stopped menstruating after just a few cycles, and her ovaries and uterus were shrunken, like those of a postmenopausal woman.

But her twin sister,Melanie Morgan, was fertile, and the mother of three children. Initially, Ms. Morgan donated eggs so that Ms. Yarber could try in vitro fertilization. Ms. Yarber had eggs implanted in her uterus twice, but did not become pregnant. At that point, the sisters consulted Dr. Silber.

He removed one of Ms. Morgan's ovaries through a tiny incision, stripped off the outer layer, which contains the eggs, and cut it into thirds. He sewed one strip to each of Ms. Yarber's ovaries, and froze the third for possible future use.

About six months later, Ms. Yarber became pregnant naturally, without any drug treatment or further surgery. The hormones produced by the transplanted ovarian tissue made her uterus enlarge to a normal size. Her daughter, weighing 7 pounds, 14 ounces, was born naturally.

"Stephanie should be able to have many more babies this way," Dr. Silber said.

He added that it was almost certain that the pregnancy came from the transplanted tissue and not from her own ovaries, because she had no eggs whatsoever.

He and Dr. Gosden described Ms. Yarber's history. A spokeswoman for St. Luke's said that the sisters were not available for interviews on Tuesday, and a phone call to the Yarber residence was not returned.

Dr. Gosden and Dr. Silber said that when they began treating the two sisters, they thought it would be rare to find a set of identical twins in which one was fertile and the other not. But since then, they have encountered other pairs, and learned that infertility is about five times as common in identical twins as in the rest of the population. Doctors do not know why. There may be hundreds of such cases in the United States, Dr. Gosden said.

"We just did our third ovarian transplant between identical twins today," Dr. Silber said. "We think there'll be a lot more."